1. Head and Face Injuries

2. Cerebral Concussion
Definition: immediate and transient posttraumatic impairment of neural functions
Estimated 250,000 or more a year
Can take up to 30 minutes or 1 hr for symptoms to appear
There are a variety of grading scales and return to play criteria. It is best to have a protocol determined by your athletic staff, ATC and physician.
Always handle head trauma with great caution

3. For more information on concussions or health issues go to www.cdc.gov
There is a Free CDC Tool Kit on Concussions for High School Coaches!
If your athlete sustains a head injury and there is no medical professional, it is always best to treat the situation with the most conservative care possible.
Each situation will be different and you may have to obtain parents consent when dealing with a minor.
An MD clearance note should always be encouraged

4. Cerebral Concussion Signs and symptoms: Dizziness Disorientation
Headache
Amnesia
Tinnitus (ringing in the ears)
Balance problems
Nausea/vomiting
Change in personality

5. Cerebral Concussion
American Academy of Neurology Concussion Grading Scale
Grade 1 (mild) Transient confusion; no LOC*; symptoms and mental status abnormalities resolve <15 min
Grade 2 (moderate) Transient confusion; no LOC; symptoms and mental status abnormalities last >15 min
Grade 3 (severe) Any LOC *LOC indicates loss of consciousness

6. Cerebral Concussion What do you do? Questions:
#1: sit athlete down and ask questions and observe signs and symptoms - ask questions related to memory and orientation to rule out amnesia
Questions:
Do you know where you are?
Can you tell me what happened?
Do you know who we are playing?
Do you have pain in your neck?
Do you remember who we played last week?

7. Cerebral Concussions Observe and check: PEARL Balance Memory
Retrograde Amnesia - can’t remember anything that occurred immediately before injury
Anterograde Amnesia - can’t remember anything that occurred after injury
Athlete must sit minutes and then reevaluate

8. Cerebral Concussion
Symptoms subside - they may return to activity - “mild head injury”
Symptoms remain - they are out for the game or practice and must be cleared by a physician to return
Any loss of consciousness (LOC) - keep athlete where they are, do not move and call 9-1-1

9. Cerebral Concussion Expected return to play:
Many different scales (clearance by MD)
Grade I = one week asymptomatic
Grade 2 = clearance by a physician, usually one to two weeks asymptomatic
Grade 3 = clearance by a neurologist, usually one to three months or more depending on severity

10. Cerebral Concussion Home care instructions
Make sure parents/guardians know situation and what happened
Make sure roommates or friends know and monitor
Have someone watch for:
Increasing headache
Disorientation
Vomiting
Impairment of consciousness
Unequal pupils
Fluids from nose and ears
If these appear, then get to MD or call 9-1-1
Controversies:
Sleep vs. no sleep: many MD’s recommend to let the athlete sleep so they can get rest but you should have someone check on them every couple of hours
Medications: make sure athletes do not take anything because it will mask the symptoms

11. Post-Concussion Syndrome
Post-concussion syndrome may appear for a variable amount of time following injury
Athlete has problems with attention (especially trying to concentrate), anxiety, abnormal giddiness and headaches

12. Second Impact Syndrome
Cause = due to rapid swelling and herniation of the brain after a second head injury
S&S = within 15 sec - min, the condition worsens rapidly, dilated pupils, LOC
Care = CALL 9-1-1

13. Facial Injuries
Jaw fracture (mandible fx): 2nd incidence of all facial fractures
Cause = blow to jaw - lower more common
S&S = deformity, loss of occlusion of teeth, pain when biting, bleeding around teeth, numbness
Care = cold packs and refer to ER or MD - rule out head injury. Full activity resumed in 2-3 months

14. Facial Injuries
Zygomatic (cheekbone fracture): Third most common facial fracture
Cause = blow to cheek
S&S = deformity in cheek region, crackling (crepitus) when you push on cheek, nosebleed, diplopia
Care = cold packs and referral - rule out head injury, healing usually takes 6-8wks

15. Orbital hematoma (black eye)
Reduce inflammation (ice and compression), check for concussion
Orbital fracture (blowout fx)
Fracture of the bones that surround the eye
S&S: restricted movement of eye, diplopia (double vision), swelling, hemorrhage, numbness
Management = ice, refer for xray
* If very painful, cover both eyes and transport in recumbant position (call 9-1-1)

16. Skull fracture Cause = direct trauma
S&S = severe headache, nausea, blood in ear canal, bleeding from nose
Raccoon eyes = ecchymosis around eyes
Battle sign = ecchymosis behind the ears
Cerebrospinal fluid = straw colored fluid in nose or ear
Care = call 9-1-1, do not move athlete, monitor vitals and ABC’s

17. Facial Injuries Dental Trauma
Tooth Fracture = very sensitive and painful (nerve exposed) - stop bleeding and if able athlete can return and see dentist after the game (24-48 hrs)
Dislocated tooth = rinse tooth and place back in socket, keep in saline (salt water) or milk, store in tooth savor
Need to see dentist within 30 minutes - refer immediately

18. Facial Injuries Nasal fracture: most common fracture of the face
S&S = nose bleed, swelling, deformity, abnormal ability or crepitus
Care = control bleeding, refer to physician
Usually can play when symptoms
subside and proper protection
is maintained

19. Facial Injuries Nosebleed: How do I stop bleeding? Ice
Have athlete lean forward and pinch bridge of nose
Place noseplug, gauze, or tissue up into nostril
Place skin lube or vaseline on noseplug to aid in clotting
Place a rolled piece of gauze under upper lip

20. Eye Injuries
Corneal abrasion: foreign object usually rubbed - athlete complains of pain, watering and eye spasm that won’t subside - refer to eye physician
Retinal detachment: painless, but athlete complains of seeing specks, flashes of light or blurred vision, usually lose part of visual field - immediate referral to eye physician